title: Pectus carinatum: the effects of orthotic bracing on pulmonary function and gradual compression on patient compliance.
abstract: OBJECTIVE
  The treatment of pectus carinatum (PC) deformity has been considered to be operative. Some authors have shown that postoperative pulmonary function is worsened. They have suggested that compromised chest wall expansion secondary to surgery leads to compromised pulmonary function. Several authors have advocated an orthotic brace for the treatment of PC. Pulmonary functions after orthotic brace treatment have not been investigated.
  
  
  METHODS
  Between April 2006 and October 2012, 61 patients presented with PC. Orthotic braces allowing gradual compression were prepared according to the anthropometric measurements of individual patients. The brace belt was tightened gradually. The brace was worn 6 h a day during the first week and the bracing time was prolonged for an additional hour per week till 16 h per day has been reached. Pre- and post-treatment echocardiography, pulmonary function tests and thorax computed tomography (CT) were obtained. The pectus severity index (Haller index) and the angle of sternal rotation were measured using CT. Satisfaction from bracing was evaluated by parents or patients at the end of the treatment.
  
  
  RESULTS
  While the mean pretreatment Haller index was 1.96 ± 0.24, the mean post-treatment index was 2.26 ± 0.32. The angle of rotation was improved by 47.5%. Forced vital capacity and forced expiratory volume in 1 second were correlated with the predicted values for age. There was no statistically significant difference between pre- and post-treatment values. No skin breakdown or bruising was encountered. The overall average satisfaction score was 3.92 ± 0.27.
  
  
  CONCLUSIONS
  We conclude that pulmonary function tests are not affected after brace treatment and gradual progression of bracing increases the patient's compliance.
authors.affiliation: Department of Pediatric Surgery, Dokuz Eylül University, Medical School, Izmir, Turkey.
authors.forename: Oğuz
authors.initials: O
authors.lastname: Ateş
authors.forename: Osman Z
authors.initials: OZ
authors.lastname: Karakuş
authors.forename: Gülce
authors.initials: G
authors.lastname: Hakgüder
authors.forename: Mustafa
authors.initials: M
authors.lastname: Olguner
authors.forename: Feza M
authors.initials: FM
authors.lastname: Akgür
mesh_terms: D000293:Adolescent; D001915:Braces; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D009139:Musculoskeletal Abnormalities / Q000628:therapy*; D010349:Patient Compliance; D012129:Respiratory Function Tests; D013249:Sternum / Q000002:abnormalities*; D013909:Thorax / Q000002:abnormalities*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Orthotic brace; Pectus carinatum; Pulmonary functions